Healthcare Provider Details

I. General information

NPI: 1093398570
Provider Name (Legal Business Name): SANDRA MARIA RUGAMA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MAIN ST
LOUISVILLE CO
80027-1894
US

IV. Provider business mailing address

1824 ALPINE DR
ERIE CO
80516-4015
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-6320
  • Fax: 303-666-6520
Mailing address:
  • Phone: 956-483-5983
  • Fax: 303-666-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003768
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number245606
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number390200000X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: